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Therapeutic hypothermia in cardiac arrest survivors: is rebound hyperthermia a significant issue with intravascular cooling?

  • T Price
  • C Poots
  • H Shields
  • R McKee
Open Access
Poster presentation
  • 242 Downloads

Keywords

Therapeutic Hypothermia Target Temperature Management Northern Ireland Cardiac Arrest Survivor Broad Inclusion Criterion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Intr

Out-of-Hospital Cardiac Arrest (OOHCA) is associated with a poor prognosis. Targeted temperature management (TTM) within Intensive Care (ICU) including therapeutic hypothermia (TH) aims to reduce cerebral reperfusion injury and improve neurological outcomes.

Within Northern Ireland (NI), Craigavon Area Hospital (CAH) is the only ICU to implement TH using an intravascular cooling device (Coolgard 3000©, Alsius UK®)

The benefit of TH has recently been disputed and many ICUs within NI have since adopted TTM to 36°C in survivors of OOHCA [1].

In view of this we aimed to benchmark our use of TH to 32-34°C, using intravascular cooling against best practice at the time of data collection.

Objectives

To assess:

· Demographics of patients receiving TH within CAH ICU

· Implementation, maintenance and temperature control during TH using intravascular cooling

· Outcomes of patients receiving TH

Against standards used in published reference journals [2, 3]

Methods

Retrospective, observational chart-based data collection.

40 patients admitted to CAH ICU, who received TH via intravascular cooling catheter (24/5/2010-30/11/2012), were identified from the Intensive Care National Audit and Research Centre (ICNARC) database.

35 patients (87.5%) had available relevant and complete data.

Results

Table 1

Indications for TH.

OOHCA with shockable rhythm

46%

OOHCA with non-shockable rhythm

23%

In-hospital cardiac arrest with shockable rhythm

11%

In-hospital cardiac arrest with non-shockable rhythm

8%

Respiratory Arrest

8%

Attempted suicide by hanging

4%

Table 2

TH using intravascular cooling.

Mean time from ROSC to target temperature of 32-34°C

8.3 hours

Mean duration of TH at temperature <34 °C

23.8 hours

Neuromuscular blockade use

28.5%

Rebound hyperthermia (>38°C) on cessation of active cooling

45.1%

Mean duration of rebound hyperthermia

8.6 hours

Table 3

Outcomes.

Mean length of ICU stay

5 days

ICU Mortality

45.7%

Destination at Hospital Discharge: Home

94.1%

Destination at Hospital Discharge: Hospice

5.9%

30 day mortality

60%

Conclusions

Overall our outcomes for a mixed ICU population with broad inclusion criteria for TH are comparable with those of published studies [2].

The use of intravascular cooling for TH was associated with minimal use of muscle relaxants allowing early neurological prognostication in our patient group.

However intravascular cooling to 32-34°C was associated with prolonged periods of rebound hyperthermia in a significant minority of patients (45.1%, mean time 8.6 hours).

We believe that TH to 32-34°C, using intravascular cooling, increases the risk of developing a rebound hyperthermia that could potentially exacerbate acquired neurological injury.

Our data supports the use of TTM to 36°C to mitigate any potential effect of rebound hyperthermia is this patient group.

References

  1. 1.
    Neilson , et al: Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest. N Engl J Med. 2013, 369: 2197-22062.CrossRefGoogle Scholar
  2. 2.
    The Hypothermia after cardiac arrest study group: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002, 346: 549-563.CrossRefGoogle Scholar
  3. 3.
    Bernard SA, Gray TW, Buist MD, et al: Treatment of Comatose survivors of cardiac arrest with induced hypothermia. N Engl J Med. 2002, 346: 557-63.PubMedCrossRefGoogle Scholar

Copyright information

© Price et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Authors and Affiliations

  • T Price
    • 1
  • C Poots
    • 1
  • H Shields
    • 1
  • R McKee
    • 1
  1. 1.Department of Anaesthesia and Intensive CareCraigavon Area HospitalCraigavonUnited Kingdom

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